Protection motivation theory in predicting cervical cancer screening participation: A longitudinal study in rural Chinese women.

OBJECTIVE: To examine factors longitudinally associated with cervical cancer screening uptake among rural Chinese women, guided by protection motivation theory (PMT). METHODS: A large sample of women (n = 2408, aged 35-65 years old) was randomly selected from a rural county in China in 2015 and followed up for 2 years. Data for demographic factors, knowledge of cervical cancer screening, screening outcome, and six PMT constructs measured at the baseline in 2015 were used to predict cervical cancer screening participation at the follow-up in 2017 using structural equation model method. RESULTS: Among the 2408 women at the baseline, 1879 (78.03%) participated in the screening services at the follow-up. In addition to significant direct effect of age, social status and baseline screening outcome, and three (perceived severity, fear arousal and response efficacy) of the six PMT subconstructs, four variables (age, social status, knowledge of cervical cancer screening, and baseline screening outcome) at the baseline were indirectly associated with screening participation, mediated by the three significant PMT subconstructs. CONCLUSIONS: Findings of this study indicate that the rate of participating in cervical cancer screening for rural women needs to be further improved. In addition to the commonly reported influential factors, PMT subconstructs play important roles in encouraging rural women in China to participate in cervical cancer screening. These longitudinal findings provided data much needed for future research to develop evidence-based intervention programs to enhance cervical cancer screening among rural women in China.

Human papillomavirus type 18/16 infection and prevalence among middle-aged and older Chinese rural women: a cross-sectional survey in Wufeng, Hubei Province.

This study aimed to measure the prevalence and potential factors related to HPV 16/18 infection among middle-aged and older Chinese rural women. The study was conducted among women aged 35-65 years in rural villages within Wufeng in Hubei Province. Data were collected using a pretested questionnaire between July and August 2015. Cervical specimens were collected for HPV DNA detection and typing by using careHPV. Pearson's Chi-square and logistic regression analyses were used to examine associations with HPV positivity. Among 1001 participants, the prevalence of HPV 18/16 positive genotyping was 15.88% (n = 159). Husbands' extramarital sex (adjusted odds ratio [OR] = 15.85, 95% confidence interval [CI] 5.76-43.59), cervicitis (adjusted OR = 9.27, 95% CI 5.06-16.99), condom usage (adjusted OR = 0.16, 95% CI 0.05-0.53), higher average number of live births (adjusted OR = 1.98, 95% CI 1.32-2.96 for two live births; adjusted OR = 3.29, 95% CI 1.39-7.81 for three or more live births) were associated with HPV infection. The prevalence of HPV infection among participating women from rural areas was higher than that in several other areas in China. Our findings can aid efforts to prevent HPV infection to lower the risk of cervical cancer.

Protection motivation theory in predicting intention to receive cervical cancer screening in rural Chinese women.

OBJECTIVE: Despite the significance of cervical cancer screening, motivating more women to participate remains a challenge in resource-limited settings. In this study, we tested the protection motivation theory (PMT) in predicting screening intentions. METHODS: Participants were women from Wufeng, a typical rural county in China. Participants (n = 3000) with no cervical cancer history were recruited from 10 randomly selected villages. As mediating variables, 6 PMT constructs (Perceived Risk, Fear Arousal, Perceived Severity, Response Efficacy, Response Cost, and Self-Efficacy) were measured using the standardized questionnaire. Structural equation modeling (SEM) method was employed to test PMT-based prediction models. RESULTS: Of the total sample, 57.77% believed that regular screening may reduce cervical cancer risk, and 45.26% agreed that women should be screened regularly. Our data fit the PMT model well (GFI = 0.95, AGFI = 0.93, CFI = 0.90, RMSEA = 0.06, SRMR = 0.04, Chi-square/df = 2.47). Knowledge of screening was directly and positively associated with screening intention. Age, annual income, and awareness of and prior experience with screening were significantly associated with screening intention by enhancing cervical cancer risk perception and by reducing response cost (P<0.05 for both). CONCLUSION: PMT can be used as guidance to investigate cervical cancer screening intentions among rural women in China with focus on cancer knowledge, some demographic factors, and awareness of and previous experience with screening. These findings, if verified with longitudinal data, can be used for intervention program development.

VIA/VILI is more suitable for cervical cancer prevention in Chinese poverty-stricken region: a health economic evaluation.

BACKGROUND: Screening is the main preventive method for cervical cancer in developing countries, but each type of screening has advantages and disadvantages. To investigate the most suitable method for low-income areas in China, we conducted a health economic analysis comparing three methods: visual inspection with acetic acid and Lugol's iodine (VIA/VILI), ThinPrep cytology test (TCT), and human papillomavirus (HPV) test. METHODS: We recruited 3086 women aged 35-65 years using cluster random sampling. Each participant was randomly assigned to one of three cervical cancer screening groups: VIA/VILI, TCT, or HPV test. In order to calculate the number of disability-adjusted life years (DALYs) averted by each screening method, we used Markov models to estimate the natural development of cervical cancer over a 15-year period to estimate the age of onset and duration of each disease stage. The cost-effectiveness ratios (CERs), net present values (NPVs), benefit-cost ratios (BCRs), and cost-utility ratios (CURs) were used as outcomes in the health economic analysis. RESULTS: The positive detection rate in the VIA/VILI group was 1.39%, which was 4.6 and 2.0 times higher than the rates in the TCT and HPV test groups, respectively. The positive predictive value of VIA/VILI (10.53%) was highest while the rate of referral for colposcopy was lowest for those in the HPV + TCT group (0.60%). VIA/VILI performed the best in terms of health economic evaluation results, as the cost of per positive case detected was 8467.9 RMB, which was 24503.0 RMB lower than that for TCT and 5755.9 RMB lower than that for the HPV test. In addition, the NPV and BCR values were 258011.5 RMB and 3.18 (the highest), and the CUR was 2341.8 RMB (the lowest). The TCT performed the worst, since its NPV was <0 and the BCR was <1, indicative of being poorly cost-beneficial. CONCLUSIONS: With the best economic evaluation results and requiring minimum medical resources, VIA/VILI is recommended for cervical cancer screening in poverty-stricken areas in China with high incidence of cervical cancer and lack of medical resources.

Knowledge about cervical cancer and barriers of screening program among women in Wufeng County, a high-incidence region of cervical cancer in China.

PURPOSE: Cervical cancer screening is an effective method for reducing the incidence and mortality of cervical cancer, but the screening attendance rate in developing countries is far from satisfactory, especially in rural areas. Wufeng is a region of high cervical cancer incidence in China. This study aimed to investigate the issues that concern cervical cancer and screening and the factors that affect women's willingness to undergo cervical cancer screening in the Wufeng area. PARTICIPANTS AND METHODS: A cross-sectional survey of women was conducted to determine their knowledge about cervical cancer and screening, demographic characteristics and the barriers to screening. RESULTS: Women who were willing to undergo screenings had higher knowledge levels. "Anxious feeling once the disease was diagnosed" (47.6%), "No symptoms/discomfort" (34.1%) and "Do not know the benefits of cervical cancer screening" (13.4%) were the top three reasons for refusing cervical cancer screening. Women who were younger than 45 years old or who had lower incomes, positive family histories of cancer, secondary or higher levels of education, higher levels of knowledge and fewer barriers to screening were more willing to participate in cervical cancer screenings than women without these characteristics. CONCLUSION: Efforts are needed to increase women's knowledge about cervical cancer, especially the screening methods, and to improve their perceptions of the screening process for early detection to reduce cervical cancer incidence and mortality rates.

Case-control study of diet in patients with cervical cancer or precancerosis in Wufeng, a high incidence region in China.

PURPOSE: To investigate the diet of patients with cervical cancer and precancerosis in the Wufeng area, a high- incidence region in China. METHODS: In the case group, 104 patients diagnosed with cervical cancer or cervical intraepithelial neoplasias (CINII/III) were recruited from the Wufeng area. Nine hundred thirty-six healthy women were selected from the same area as the matched controls. A questionnaire, which included questions about general lifestyle conditions, smoking and alcohol status, source of drinking water, green tea intake, and diet in the past year, was presented to all participants. RESULTS: Green tea intake (P=0.022, OR=0.551, 95% CI=0.330-0.919) and vegetable intake (P=0.035, OR=0.896, 95% CI=0.809-0.993) were identified as protective factors against cervical cancer or CINII/III. There was no indication of any associations of other lifestyle factors (smoking status, alcohol status, source of drinking water) or diet (intake of fruit, meat/egg/milk, soybean food, onion/garlic, staple food and pickled food) with cervical cancer. CONCLUSIONS: The results suggest that eating more fresh vegetables and drinking more green tea may help to reduce the risk of cervical cancer or CINII/III in people of the Wufeng area.

Prevalence and type distribution of high-risk human papillomavirus infections among women in Wufeng County, China.

OBJECTIVE: The aim of this survey was to assess the prevalence and type distribution of oncogenic human papillomavirus (HPV) infections among women in Wufeng County of Hubei province, where the cervical cancer mortality rate is the highest in China Cervical. METHODS: DNA samples were collected from 1,100 women, then screened and quantified by a multi-fluorescent, quantitative real-time PCR assay. The cervical DNA samples were then re-typed by real-time PCR using seven-pair primers of high-risk (HR) HPVs designed to detect types 16, 31, 18/45, 33, 52, 58, and 67. RESULTS: The overall prevalence of HR HPVs was 11.14 % (95 % CI, 9.74-13.72 %) in Wufeng County, which was not statistically different between Tu (12.17 %; 95 % CI, 10.03-12.34 %) and Han nationality (8.95 %; 95 % CI, 3.55-14.35 %). Among different types of HPV, HPV 16 was the most frequently detected genotype, followed by HPV 52, 58, 18/45, and 31. The most prevalent types of HR HPV in Tu nationality were HPV 16, 52, and 58, and the most prevalent types of HR HPV in Han nationality were HPV 16, 33, and 18/45. The overall prevalence of HPV was highest in the 20-24 year age group (21.43 %; 95 % CI, 17.56-25.30 %) and the prevalence of HR HPV was associated with education. CONCLUSIONS: HPV 16, 52, and 58 are common genotypes in Wufeng County, and support the hypothesis that second-generation HPV prophylactic vaccines, including HPV 52 and 58, may offer higher protection for women in China and other areas of Asia. The findings of this study contribute to preventive and screening measures in clinical practice.

Primary screening for breast diseases among 17618 women in Wufeng area, a region with high incidence of cervical cancer in China.

In this study, the current status for breast diseases in a region with high-incidence of cervical cancer were epidemiologically investigated. From March to August, 2009, 17618 women, from Wufeng area of Hubei province, China, were recruited to screen breast diseases by using breast infrared diagnostic apparatus. Other diagnostic methods, such as B-mode ultrasound, X-ray mammography, needle biopsy and pathological examination were, if necessary, used to further confirm the diagnosis. The screening showed that 5990 of 17618 cases (34.00%) had breast diseases, 5843 (33.16%) had mammary gland hyperplasia, 48 (0.27%) had breast fibroadenoma, 11 (0.06%) had breast carcinoma, and 88 (0.50%) had other breast diseases. The peak morbidity of breast cancer was found in the women aged 50-60 ages. The morbidity of breast cancer was significantly increased in women elder than or equal to 50 years old (n=8, 0.157%) in comparison with that in the subjects younger than 50 years old (n=3, 0.024%) (u=2.327, P<0.05). It was shown that the occurrence of breast diseases was concentrated in women aged 20-40 years, while the total morbidity reached its peak at the age of 30 years and then decreased sharply after age of 40. Compared with the patients elder than or equal to 40 years old (n=3289, 27.46%), the morbidity rate of breast diseases was significantly increased in women less than 40 years old (2648 cases, 47.18%; P<0.001). However, there was no significant difference in the morbidity of breast diseases between the age group of 20-29 years and that of 30-39 years (P=0.453), and both of them were high. There was no significant association between the morbidity of breast diseases and cervical cancer. Since the morbidity of breast diseases was higher among young women, more attention should be paid to the screening of breast diseases among young women for early diagnosis.

Primary Screening for Breast Diseases among 17618 Women in Wufeng Area, a Region with High Incidence of Cervical Cancer in China / 华中科技大学学报（医学）（英德文版）

In this study,the current status for breast diseases in a region with high-incidence of cervical cancer were epidemiologically investigated.From March to August,2009,17618 women,from Wufeng area of Hubei province,China,were recruited to screen breast diseases by using breast infrared diagnostic apparatus.Other diagnostic methods,such as B-mode ultrasound,X-ray mammography,needle biopsy and pathological examination were,if necessary,used to further confirm the diagnosis.The screening showed that 5990 of 17618 cases (34.00％) had breast diseases,5843 (33.16％) had mammary gland hyperplasia,48 (0.27％) had breast fibroadenoma,ll (0.06％) had breast carcinoma,and 88 (0.50％) had other breast diseases.The peak morbidity of breast cancer was found in the women aged 50-0 ages.The morbidity of breast cancer was significantly increased in women elder than or equal to 50 years old (n=8,0.157％) in comparison with that in the subjects younger than 50 years old (n=3,0.024％) (u=2.327,P＜0.05).It was shown that the occurrence of breast diseases was concentrated in women aged 20-40 years,while the total morbidity reached its peak at the age of 30 years and then decreased sharply after age of 40.Compared with the patients elder than or equal to 40 years old (n=3289,27.46％),the morbidity rate of breast diseases was significantly increased in women less than 40 years old (2648 cases,47.18％; P＜0.001).However,there was no significant difference in the morbidity of breast diseases between the age group of 20-29 years and that of 30-39 years (P=0.453),and both of them were high.There was no significant association between the morbidity of breast diseases and cervical cancer.Since the morbidity of breast diseases was higher among young women,more attention should be paid to the screening of breast diseases among young women for early diagnosis.

[Clinical analysis of 21 cases of cervical adenosquamous carcinoma].

OBJECTIVE: To study the clinical characteristics, treatment modalities and prognosis of cervical adenosquamous carcinoma. METHODS: The data of 21 patients with adenosquamous cervical cancer who were admitted into Zhongnan Hospital, Wuhan University from Jan 2001 to Dec 2005 were analyzed retrospectively. Six patients received surgical therapy only and 15 patients received combined therapy. RESULTS: Seven cases were with positive pelvic lymph node metastases and 3 cases were with ovarian metastases. The median survival time of the combined therapy group and surgical therapy group was 54 and 20 months, respectively. In stage I and stage II patients, the median survival time of the combined therapy group and surgical therapy group was 66 and 20 months, respectively. The difference was significant between the two groups (P < 0.05). CONCLUSIONS: Combined therapy should be given to patients with adenosquamous carcinoma of the cervix. Surgical therapy and chemotherapy play an important role in the management and prognosis of adenoquamous carcinoma of cervix. Preserve of ovary for patients with adenosquamous carcinoma of the cervix should only be done when the ovary is confirmed free from any malignant involvement by pathology.